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Facility and Provider Grievances, Appeals and Complaints in the Time of COVID-19

What is the best way to handle patient grievances, appeals and complaints during COVID-19?

The current state of liability laws against health care providers during the pandemic can be divided into two main categories: those that involve the care and treatment of COVID-19 patients, and those that involve everybody else. 

The Public Readiness and Emergency Preparedness Act for Medical Countermeasures Against COVID-19 and its now 4 Amendments, "the PREP Act" provide federal liability protections to a broadly defined list of covered "Qualified Persons" making decisions and delivering (or not delivering) COVID-19 countermeasures during the pandemic, recently expanded to include pharmacists and telehealth professionals. 

Here in New York, the decision of the state to order COVID-19 residents of nursing homes to be sent back to their facilities after hospital discharge, even while still contagious, has sparked a number of statewide criticisms, and the State Attorney General's Office is reviewing both the data on the subject and the potential liability of nursing homes for failing to protect their residents under the circumstances of the pandemic. 

The issue of medical malpractice claims against providers for COVID-19 in light of the PREP Act, and for non-COVID-19 medical care, while not directly named in the PREP Act, should be taken to a medical malpractice attorney for specific guidance. 

But another important avenue for aggrieved patients and their loved ones to pursue is the route of filing grievances, complaints, and patient appeals. Quality facilities, including hospitals, hospice, nursing homes and others, actively seek patient satisfaction data, want to know what is happening outside the C Suites, and want to correct deficiencies expeditiously. These offices are excellent opportunities to inform a facility about problems, and get redress. 

While this may not result in refunds or any remuneration for the patient or their family the way a medical malpractice claim might, it can help identify systemic problems or specific negligent staff, and will allow a quality facility the opportunity to stop the harm from occurring to the next patient. For this effort, it is important to highlight the facility's  Patients Rights, Patient Advocate Office, the facility Ombudsman, and the facility Quality Assurance Department. Patients should focus on specific items of grievance and expect to hear back when appropriate corrective measures have been put in place. If a future medical malpractice claim is anticipated, it is advisable to both sides to have a medical malpractice attorney engaged to assist in the grievance, appeal, and complaint process. 

These efforts are a valuable opportunity for quality facilities to make needed corrections, and facilities are encouraged to make that process as responsive as possible to receive, diffuse, and correct patient grievances. Those facilities that are not responsive to these avenues, are instead subject to being reported to the State of New York and to the patient's health insurance company that pays the bill. The avenues available to patients and their representatives for unaddressed grievances include the New York State Department of Health, the New York State Attorney General's Office, the New York State Department of Finance (formerly known as the Insurance Department) and the health care insurance payors, including Medicare. Facilities are credentialed, accredited, and licensed. Any serious complaints must be investigated and could result in negative findings, negative survey results, disciplinary actions against individually licensed individuals or a facility, required corrective action plans, loss of credentials, loss of participation in certain health insurance plans, loss of accreditation, or even loss of license to operate. 

"Consumers and providers will also find information on how to file a confidential complaint about healthcare quality, review public health laws and regulations, and gain access to clinical guidelines and other healthcare best practices." New York State Department of Health